Guidelines for the diagnosis and treatment of chronic obstructive lung disease--effective and necessary

The independent practice of the art of medicine which doctors took for granted in the past has ended. With almost revolutionary speed, insurers, administrators and politicians have distributed the unique relationship between doctors and their patients. Treatment and diagnostic guidelines in different clinical entities have been based on the pillars of medicine - controlled studies and/or a common consensus among specialists and practitioners. These dynamic activities have enriched our knowledge and practice of medicine. However, only the continuing direct collaboration of physicians at all levels and constant adjustment to changing conditions make these guidelines applicable to the ever changing world of medicine. Chronic obstructive lung disease is one such clinical entity that requires uniform guidelines. Issues that have to be addressed are not only who belongs in this category but also what interventions, such as lateral chest radiographs, CT scans and sleep lab investigations, should be performed as well as the indications for costly therapies such as long-term home oxygen, alpha-1-protease inhibitor augmentation therapy and lung transplantations. Instead of looking at guidelines at straitjackets that limit excellence in the practice of medicine, medical associations should treat them as an opportunity to define their own quality standards. By doing so, the medical community would eliminate the influence of administrative directions or gatekeeper decisions, while patients and the whole population would greatly benefit.